Central Illinois Radio Club Membership Form

Central Illinois Radio Club, Application for Membership

A person doesn't need to be a licensed Amateur Radio operator to join the Central Illinois Radio Club
PLEASE PRINT LEGIBLY
Last*
First*
M.I.
Date

MonthDayYear
Date
Street address*
Apartment/Unit
City*
State*
Zip*
Phone*
Email*
example@example.com
Call Sign*
License Class*
New Member?*

YesNo
Do you give permission to the CIRC board to release your email and physical address to other members of the club if requested?*

YesNo
****For new members the first year's membership, or remaining portion thereof shall be free. The free period ends in December of the sign-up year.

Individual membership - $30.00 - please mail check or use PayPal link on website
Family membership - $40.00 - please mail check or use PayPal link on website
Family Member #1

_____________________________
Family Member #1 Full Name
Family Member #1 Phone
Family Member #1 Email
example@example.com
Family Member #1 Call Sign
Family Member #1 License Class
Family Member #2

_____________________________
Family Member #2 Full Name
Family Member #2 Phone
Please enter a valid phone number.
Family Member #2 Email
example@example.com
Family Member #2 Call Sign
Family Member #2 License Class
Family Member #3

_____________________________
Family Member #3 Full Name
Family Member #3 Phone
Family Member #3 Email
example@example.com
Family Member #3 Call Sign
Family Member #3 License Class
WHAT ARE YOUR SPECIFIC INTERESTS WITHIN THE HOBBY?
ATV HFConstructionVHF/UHFPacket RadioYouth ActivitiesQRPSatellite Communications EchoLinkContesting Other Public Service Events Emergency CommunicationsFox Hunting
WHAT ARE YOUR SPECIFIC INTERESTS WITH THE HOBBY?

HFATVConstructionVHF/UHFPacket RadioYouth ActivitiesQRPSatelite CommunicationsEchoLinkEmergency CommunicationsPublic Service EventsFox HuntingContestingOther
What would you like to do at meetings
What activities do you think the club should participate in or sponsor
Please send your check or money order to;

Central Illinois Radio Club P. O. Box 993

Bloomington, IL 61702-0993 If you have any questions, please email the club => centralillinoisradioclub@gmail.com
Should be Empty:

PLEASE PRINT LEGIBLY

Family Member #1

Family Member #2

Family Member #3

WHAT ARE YOUR SPECIFIC INTERESTS WITHIN THE HOBBY?